The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. J Orthop Trauma. Apr;25(4) doi: /BOT.0bef9ad6e. Modified Kocher-Langenbeck approach for the stabilization of posterior wall. Kocher-Langenbeck approach for acetabular # fixation– sath, Chennai, India. Arun Dr. Loading Unsubscribe from Arun Dr?.

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The Kocher-Langenbeck Approach

They are tagged and incised 1 cm lateral from their femoral insertions to protect the medial circumflex femoral artery. Understand the new fragment position aproach traction application Video 2 and maintain traction only for the time period that is needed be mindful of traction neurapraxia. This is accomplished through the splitting of the muscle fibers of the gluteus maximus and the release of its tendinous femoral insertion along with the release of the piriformis and the short external rotators from their femoral insertion at the piriformis fossa.

Exposure This approach allows direct access to the area indicated in dark brown, limited wpproach by the neurovascular bundle.

The Kocher-Langenbeck Approach

The Langrnbeck approach is the workhorse for the surgical management of acetabular fractures and provides sufficient access to the majority of posterior based acetabular fractures Detach the external rotator muscles Isolate the piriformis tendon. Start the skin incision a few centimeters distal and lateral to the posterior superior iliac spine.


Chest rolls that allow for free abdominal movements are used. Ann R Coll Surg Engl.

The labrum, whenever possible, should be langebbeck. The sciatic nerve see illustration lies posterior to the gemelli and internal obturator muscles, and anterior to the piriformis muscle, between the greater trochanter and the ischial tuberosity.

Inspect the fracture fragments. September 5; 94 The osteotomy is then carried out from the posterior trochanter anteriorly to mobilize the fragment.

In transverse and T-type fractures, the femoral head tends to keep the acetabular fracture surfaces apart because of gravity, thus creating difficulties in reduction. The Kocher-Langenbeck approach is an approach to the posterior lngenbeck of the acetabulum. Bring the C-arm image intensifier from the contralateral side and ensure that all of the necessary fluoroscopic views can be acquired.

April 26; 12 1: Surgical approaches to the acetabulum and modifications in technique. This is particularly true for the conjoint tendon where passage of a needle into the tendon stump may injure the medial femoral circumflex artery.

Develop kodher interval between the superior aspect of the quadratus femoris muscle and the conjoined tendon gemelli and obturator internus with blunt dissection. Instruct the patient to take universal hip precautions if posterior wall reconstruction has been done. Overview Introduction The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12.


Epub Nov 2.

Standard approaches to the acetabulum part 1: Skeletal traction through the distal end of the ipsilateral femur is also routinely used. Please review our privacy policy. Have the patient return for clinical and radiographic follow-up at 2 and 6 weeks and then at 3, 6, 12, and 24 months postoperatively. After dissection through the distal part of the trochanteric bursa, the surgeon palpates the undersurface of the gluteus maximus muscle with his or her index finger and identifies the raphe, which separates the upper one-third from the lower two-thirds of the muscle which have a different vascular supply: Click here to view.

Meticulous hemostasis, application of drains, and watertight lwngenbeck are the final steps of langnbeck operation.

Posterior Approach to the Acetabulum (Kocher-Langenbeck)

Acetabular fractures with marginal impaction: Manipulation of the anterior column in transverse or T-type fractures is alproach, but can be accomplished via a clamp through the greater sciatic notch, taking care to avoid injury of the intrapelvic structures. Approach – more detail Back.

Reflect the piriformis belly laterally to expose the retroacetabular surface to the greater sciatic notch.